<div class="layuimini-container">
    <form id="app-form" class="layui-form layuimini-form">
        
        <div class="layui-form-item">
            <label class="layui-form-label required">头像</label>
            <div class="layui-input-block layuimini-upload">
                <input name="image" class="layui-input layui-col-xs6"   placeholder="请上传头像" value="">
                <div class="layuimini-upload-btn">
                    <span><a class="layui-btn" data-upload="image" data-upload-number="one" data-upload-exts="png|jpg|ico|jpeg" data-upload-icon="image"><i class="fa fa-upload"></i> 上传</a></span>
                    <span><a class="layui-btn layui-btn-normal" id="select_image" data-upload-select="image" data-upload-number="one" data-upload-mimetype="image/*"><i class="fa fa-list"></i> 选择</a></span>
                </div>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">佣金获得者</label>
            <div class="layui-input-block">
                <input type="text" name="com_recipient" class="layui-input"  placeholder="请输入佣金获得者" value="">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">佣金类型</label>
            <div class="layui-input-block">
                <input type="text" name="com_type" class="layui-input"  placeholder="请输入佣金类型" value="">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">所得佣金</label>
            <div class="layui-input-block">
                <input type="text" name="com_amount" class="layui-input"  placeholder="请输入所得佣金" value="">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">状态</label>
            <div class="layui-input-block">
                <input type="text" name="state" class="layui-input"  placeholder="请输入状态" value="">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">0表示待团长收货，1表示用户已收货</label>
            <div class="layui-input-block">
                <input type="text" name="status" class="layui-input"  placeholder="请输入0表示待团长收货，1表示用户已收货" value="0">
            </div>
        </div>
        <div class="hr-line"></div>
        <div class="layui-form-item text-center">
            <button type="submit" class="layui-btn layui-btn-normal layui-btn-sm" lay-submit>确认</button>
            <button type="reset" class="layui-btn layui-btn-primary layui-btn-sm">重置</button>
        </div>

    </form>
</div>